What Medical Schemes Offer

Medical schemes are basically South African bodies that prove you with the necessary medical cover to ensure you receive the best possible medical care available. They are not insurance companies but statutory bodies instead. What Medical Schemes OfferWithin in each scheme you have a choice between different plans and options.

All schemes are regulated by the Council of Medical Schemes. The council is government appointed body that can assist you should you have any disputes with a scheme. They also have a list available of all the medical service providers in South Africa.

Some of the biggest medical aid schemes in South Africa are:

We have a dual health care system in South Africa that includes a public and private health system. Medical care at the public system is free but very expensive in the private system; you need a medical aid to cover the costs of private healthcare.

With medical aid you pay a premium that insures your health; this premium then covers your medical expenses. Be aware that schemes do have claims limits based on their benefit schemes and the plan you purchase.

To get your medical aid plan quote by email Click Here

You need to be aware of the words “payment in full” in particular. This usually means “payment in full” at the rates set by the medical aid in question, and not payment of the actual medical bill in full.

Medical schemes vary a lot in relation to the plans and options they offer, and with all these variations it is sometimes difficult to find a scheme that suits your personal and family’s needs.

Factors you should take into consideration when acquiring medical insurance are:

  • The costs involved, medical plans can be expensive find something that suits your pocket.
  • Your current health status, if you have chronic illness you might need a bigger plan.
  • The specific benefits you need, these can be based on pre-existing conditions and the lifestyle you follow.
  • Exclusions and waiting periods,
  • Medical scheme rates; this is the rate the scheme is willing to pay the service provider.
  • Are comfortable with supporting only a certain chain of service providers.
  • Will you be able to abide by the rules the scheme has.
  • There is a wide range of medical options available:
  • Comprehensive or traditional plans: Covers both day to day and hospital needs.
  • Hospital plans: Covers only in-hospital medical costs and some chronic conditions.
  • Medical savings accounts: An additional option to some plans, this can cover above threshold rates or your day to day medical expenses.
  • Network options: This plan offers cover at a selected network of service provides. Cover is for both hospital and day to day medical needs. These plans are mostly income related, and the premiums are decided accordingly.

With all these options, choosing a medical plan that is suited to your needs could be a difficult choice to make. Most medical schemes have websites or call centres you can visit to assist with your choice, but a medical broker can be of assistance as well. © Medical Aid Plan




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